Patients with psoriasis treated with biological therapy, which is protein-based infusions to suppress inflammation, had significant reductions in high-risk plaque in cardiac arteries, according to a study published today in Circulation: Cardiovascular Imaging, an American over a year Heart Association Journal.
Chronic inflammation in people with psoriasis is associated with a higher risk of developing coronary artery disease. Biological therapy drugs are proteins that are administered by injection or infusion that suppress the inflammatory process by blocking the action of cytokines, which are proteins that promote systemic inflammation.
Previous research has shown a clear link between psoriasis and high risk coronary plaque development. This study provides the characterization of a lipid-rich necrotic core, a dangerous type of coronary plaque made up of dead cells and cell debris that is prone to rupture. A broken plaque can lead to a heart attack or stroke.
"An inflamed plaque that is prone to rupture increases the risk of a heart attack five-fold in ten years," said Dr. Nehal N. Mehta, MSCE, FAHA, lead study author, lead investigator at Lasker, and chief of the Lab of Inflammation and Cardiometabolic Disorders at the National Heart, Lung and Blood Institutes of the National Institutes of Health in Bethesda, Maryland.
This is the first time a human imaging study has shown what a year of persistent, untreated inflammation can do to the arteries of the heart and that we can reverse that damage. Untreated inflammation is dangerous. You're just waiting for a heart attack or stroke. "
Nehal N. Mehta, MD, MSCE, FAHA, lead study author and Lasker's lead researcher and director of the Inflammation and Cardiometabolic Diseases Laboratory, National Institute of the Heart, Lung and Blood, National Institutes of Health
The analysis included 209 middle-aged (37-62 years) patients with psoriasis who participated in the National Institutes of Health's Psoriasis Atherosclerosis Cardiometabolic Initiative, an ongoing observational study. Of these participants, 124 received biological therapy and 85 were in the control group, who received only topical creams and light therapy.
To measure the effects of the biological therapy on the arteries of the heart, the researchers performed cardiac computed tomography (CT) scans on all study participants before starting therapy and one year later. The CT results between the two groups were then compared.
At baseline, participants with psoriasis had a low cardiovascular risk compared to traditional cardiovascular risk assessments, and severe psoriasis had a higher body mass index (BMI), a highly sensitive C-reactive protein (a measure of systemic inflammation), and higher associated levels of plaque of the coronary arteries.
After one year of treatment, patients receiving biological therapy were compared with the control group. Researchers found:
Biological therapy was associated with an 8% reduction in coronary plaque. In contrast, those in the control group showed a slightly increased progression of coronary plaques.
Even after adjusting cardiovascular risk factors and psoriasis severity, patients treated with biological therapy had decreased coronary plaque.
"After statin therapy, coronary plaque is reduced by approximately 6-8%. Similarly, our treatment with biological therapy reduced coronary plaque by the same amount after one year. These results suggest that biological therapy should be used for treatment psoriasis can be just as beneficial as statin therapy on cardiac arteries, "Mehta said.
This study has implications for people with psoriasis and potentially people with other chronic inflammatory diseases such as HIV, lupus, and rheumatoid arthritis, who are also at increased risk for heart disease.
"We have never been able to demonstrate a cure for such an inflamed plaque in humans. The biological therapy reduces systemic inflammation and activation of the immune system and has a beneficial effect on improving overall vascular health," said Mehta. "Imagine we can treat both psoriasis and coronary artery disease with one therapy – that is the question that needs to be asked in future studies."
The results of the study should be interpreted with caution as they were limited by a short follow-up period and a relatively small number of patients. Larger, randomized controlled trials are needed to better understand how changes in coronary plaque in people with psoriasis can lead to a reduction in heart attacks and strokes.
American Heart Association
Choi, H. et al. (2020) Treatment of psoriasis with biological therapy is linked to an improvement in the lipid-rich necrotic core of the coronary artery plaque. Circulation: cardiovascular imaging. doi.org/10.1161/CIRCIMAGING.120.011199.